Pediatric Intensive Care Unit (PICU)

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Sepsis

What Is Sepsis?

Sepsis is when the immune system responds to an infection by attacking the body's own organs and tissues. The infection can be in many body parts, including the lungs, intestines, urinary tract, or skin.

Sepsis causes the body's normal reaction to infection to go into overdrive. Bacteria from the infection and the toxins they create can change a person's body temperature, heart rate, and blood pressure, and prevent the body's organs from working properly.

Sepsis may lead to serious complications that affect the kidneys, lungs, brain, and heart, and can even cause death.

Who Can Get Sepsis?

Sepsis can affect people of any age, but is more common in:

  • babies under 3 months, whose immune systems haven't developed enough to fight off overwhelming infections
  • the elderly
  • people with chronic medical conditions
  • those with compromised immune systems from conditions such as HIV or cancer

What Are the Signs of Sepsis?

Sepsis in newborns can produce a variety of symptoms. Often, these babies "just don't look right" to their caretakers.

Sepsis Is a Medical Emergency

If your infant is less than 3 months old, has a rectal temperature of 100.4°F (38°C) or higher, seems very drowsy, is irritable, won't eat, has difficulty breathing, or appears ill, take your baby to see a doctor immediately.

In older babies and children, symptoms may include a fever, irritability, difficulty breathing, and drowsiness. A child may also seem irritable, confused, have trouble breathing, have a rash, appear ill, or complain that his or her heart feels like it's racing. Call your doctor right away if your child has these symptoms.

Other symptoms of sepsis in newborns and infants include:

  • decreased tone (floppiness)
  • changes in heart rate — either faster than normal (early sepsis) or much slower than usual (late sepsis, usually associated with shock)
  • periods when the baby seems to stop breathing for more than 10 seconds
  • change in skin color — becoming pale, patchy, and/or blue
  • jaundice (when the skin and eyes look yellow)
  • rash
  • peeing less than usual
  • bulging or fullness of the soft spot on the baby's head

A child with sepsis may have started with an infection such as cellulitis or pneumonia that seems to be spreading and/or getting worse, not better.

How Is Sepsis Diagnosed?

Lab tests play a key role in confirming or ruling out sepsis in a child. These can include:

  • Blood tests: to see if bacteria are in the blood or to see how well organs, such as the liver and kidneys, are working
  • Urine test: to see if there are bacteria in the pee
  • Lumbar puncture (spinal tap): testing spinal fluid to see if the baby could have meningitis (an infection of the membranes covering the brain and spinal cord)
  • X-rays: especially of the chest to check for pneumonia
  • Testing fluids inside any medical tubes (IV tubes, catheters, shunts, etc.) for signs of infection

How Is Sepsis Treated?

Sepsis, or even suspected cases of sepsis, will be treated in the hospital, where doctors can closely watch the child and give antibiotics intravenously (into a vein through an IV) to fight the infection.

Usually, doctors start infants with sepsis on antibiotics right away — even before the diagnosis is confirmed. If needed, babies might get IV fluids to keep them hydrated, blood pressure medicine to keep their hearts working properly, and respirators to help them breathe.

Causes of Sepsis

Bacteria are almost always the cause of sepsis in newborns and infants.

  • Premature babies in the neonatal intensive care unit (NICU) are particularly at risk for sepsis because their immune systems are not as developed as other babies'. Also, their care usually involves IV lines, catheters, and tubes. The incisions made when these are placed can provide a path for bacteria, some of which normally live on the skin's surface, to get inside the baby's body and cause an infection.

In some cases of sepsis in newborns, bacteria enter the baby's body from the mother during pregnancy, labor, or delivery. Pregnancy complications that can increase a newborn's risk of sepsis include:

  • maternal fever during labor
  • an infection in the uterus or placenta
  • premature rupture of the amniotic sac (before 37 weeks of gestation)
  • rupture of the amniotic sac very early in labor (18 hours or more before delivery)

Group B Strep and Sepsis

Some sepsis cases can be avoided by preventing the transmission of group B streptococcus (GBS)— also called "group B strep" or "baby strep" — from mother to child during childbirth. Pregnant women can have a simple swab test between the 35th and 37th weeks of pregnancy to see if they carry the GBS bacteria.

A woman who tests positive for GBS can get IV antibiotics during labor. It's best if these antibiotics are given at least 4 hours before delivery, so women who are GBS positive and in labor should go to the hospital early.

Women are at greater risk of carrying GBS if they have a fever during labor; if the amniotic sac ruptures prematurely; or if they had other children with sepsis or other diseases triggered by GBS, such as pneumonia or meningitis. A woman who has not been tested for GBS, but has one of these risk factors, may receive IV antibiotics during labor to lower the risk to her newborn.

Preventing Infections

Another way to help prevent some types of sepsis is through vaccination. Immunizations routinely given to infants today include ones against certain strains of pneumococcus and Haemophilus influenzae type b that can cause sepsis or occult bacteremia, an infection of the blood.

Regular hand washing is the best way to prevent infection. Also, make sure people who are sick don't get close to your baby. Kids and adults who live with or help care for infants should be up to date with their vaccinations.

For children with medical devices like catheters or long-term IV lines, make sure to follow the doctor's directions for cleaning and using the device.

When to Call the Doctor

Symptoms of sepsis can be very hard to identify in newborns and young infants. So call your doctor immediately or get emergency medical care if your baby shows any of these symptoms:

  • vomiting
  • no interest in feeding
  • fever (100.4°F [38°C] or higher rectal temperature) in newborns and young infants
  • labored or unusual breathing
  • change in skin color (paler than usual or mildly bluish) or a rash
  • change in the sound of your baby's cry or excessive crying
  • change in your baby's muscle tone — either seeming too stiff or especially floppy
  • a slower or faster heart rate than usual
  • bulging or fullness of the "soft spot" on the baby's head
  • peeing less than usual
  • any type of behavior or appearance that concerns you

If your older infant or child has fever, vomiting, a rash, trouble breathing, a change in skin color, feels like his or her heart is racing, or is very drowsy, irritable, or confused, call the doctor or get emergency medical care immediately.

These signs don't necessarily mean a child has sepsis, but it's important to let the doctor know to make sure an infection is caught before it becomes worse.

Reviewed by: Adalberto Torres Jr., MD
Date reviewed: September 05, 2017